Summary

What is known?
  • Troponin testing forms a central part of the algorithm for the diagnosis of myocardial infarction in the emergency department (ED), as recommended by international guidelines.

  • A range of clinical factors are known to be associated with troponin concentrations above the manufacturer-defined upper limit of normal.

  • There is emerging evidence that higher-sensitivity troponin assays may have a role in prognosis even in patients without a presentation consistent with myocardial infarction.

What is the question?
  • The study aimed to test whether a contemporary sensitivity troponin (cs-cTn), measured in ED, may be a biomarker for clinical outcome, irrespective of the indication for its measurement.

What was found?
  • In a consecutive population of 5,708 patients presenting to ED, increasing contemporary sensitivity troponin concentrations were associated with increasing hospital admission, length of stay and mortality

  • Contemporary sensitivity troponin testing is already being performed outside its original purpose. These results should help further inform clinicians about the importance of interpreting abnormal contemporary sensitivity troponin results in the clinical context.

What is the implication for practice now?
  • These results should help further inform clinicians about the importance of interpreting contemporary sensitivity troponin results in the clinical context.

  • This study suggests that contemporary sensitivity troponin may provide a useful marker of prognosis on presentation to the emergency medical services.

  • Further study is now required to evaluate the role of high-sensitivity troponin as a prognostic marker in other contexts and to assess whether any medical interventions can alter the prognosis in these patients.